Clinical Cystoid Macular Edema Research Articles

Changes in central macular thickness before and after cataract surgery evaluated by optical coherence tomography in non-diabetic patient

Background: Optical coherence tomography (OCT) has been useful for objectively observing central macular thickness (CMT) changes inpre-operative and post-operative uneventful cataract surgery. Aims and Objectives: This study was done to compare changes in CMT in small incision cataract surgery (SICS) and phacoemulsification surgery and to illuminate the OCT features of CMT after uneventful cataract surgery. Materials and Methods: A prospective observational study was done at the tertiary eye care center from December 2019 to November 2020, a total of 60 patients underwent SICS and Phacoemulsification cataract surgery, were followed and examined postoperatively at day 1, 1 week, 1 month, and 6 months for whole ocular examination and OCT. Results: Comparison analysis was performed using Friedman’s analysis of variance test.In SICS and Phacoemulsification group, statistical analysis differences between the mean CMT at pre-operative, post-operative 1 week, 1 month, and 6 months were found statistically significant (P > 0.001), subclinical macular edema (increase CMT without affecting visual acuity) was noted at 1 week and 1 month reviews. Conclusion: The changes in CMT after cataract surgery are reversible, since the maximum measured increase in macular thickness at 1 month after surgery then gradually decreased at 6 months follow-up. This increase remained subclinical, and no evidence of clinical cystoid macular edema was seen on OCT.

Incidence of clinical and subclinical macular edema in patients submitted to phacoemulsification in a university health service

Introduction: The incidence of cystoid macular edema (CME) after cataract surgery varies substantially and depending on the diagnostic method used. In addition, other factors that influence the incidence of CME are the technique of surgery and the associated comorbidities. Objective: The aim of the present study was to evaluate the incidence of EMC after uncomplicated phacoemulsification surgery, using the spectral domain optical coherence tomography (OCT). Methods: The incidence of sub-clinical and clinical CME was evaluated in 14 patients who underwent uncomplicated phacoemulsification surgery, using OCT before the surgical procedure and after seven and 28 days after it. The volunteers could not use a prostaglandin analogue or present any retinopathy that compromised visual acuity. Results: The incidence of clinically significant CME was 6.4%, however retinal thickening by OCT was observed in all patients in the fourth postoperative week. Regarding gender and laterality, the percentages were similar. Conclusion: In this study, we obtained a low incidence of EMC in patients assisted at this center, corroborating multicenter studies.

Effect of intracameral phenylephrine 1.0%-ketorolac 0.3% on postoperative cystoid macular edema, iritis, pain, and photophobia after cataract surgery.

To assess the effectiveness of intracameral phenylephrine-ketorolac during cataract surgery compared with postoperative topical steroids in reducing the incidence of postoperative clinical cystoid macular edema (CME) confirmed via optical coherence tomography (OCT), breakthrough iritis, pain, and photophobia. Ambulatory surgical center/clinical practice. Retrospective 2-cohort study. This study of cataract surgery patients compared the incidence of postoperative CME, breakthrough iritis, pain, and photophobia between patients receiving either intracameral phenylephrine 1.0%-ketorolac 0.3% during surgery or topical loteprednol 0.5% 2 days preoperatively, tapered postoperatively. Patients with prior CME or at high risk for postoperative CME, combined cataract/glaucoma surgery, and medication protocols different from those studied here were excluded. All eyes received bromfenac 2 days preoperatively and 10 weeks postoperatively. The study enrolled 2218 eyes (n = 1402). The phenylephrine/ketorolac treatment group included 1334 eyes (n = 830) and the topical loteprednol control group included 884 eyes (n = 572). The groups were comparable in age, race, gender, and perioperative characteristics. Clinical CME incidence was significantly lower in the phenylephrine-ketorolac group (0.52% vs 1.47%, P = .021). The phenylephrine-ketorolac group also had significantly lower breakthrough iritis (1.72% vs 4.86%, P < .001) and pain (1.27% vs 4.19%, P < .001) than the topical loteprednol group. The incidence of photophobia trended lower for the phenylephrine/ketorolac group relative to the topical loteprednol group (0.90% vs 1.13%, respectively, P = .590) but was not statistically significant. Intracameral phenylephrine/ketorolac and topical nonsteroidal antiinflammatory drugs (NSAIDs) without postoperative topical steroids significantly reduced postoperative clinical CME, breakthrough iritis, and pain after cataract surgery when compared with conventional perioperative topical steroids and NSAIDs.

Functional and anatomical evaluation of the effect of nepafenac in prevention of macular edema after phacoemulsification in diabetic patients.

To evaluate the effect of prophylactic administration of nepafenac in prevention of macular edema occurring in diabetic patients after phacoemulsification and to investigate the correlation between optical coherence tomography (OCT) foveal thickness and multifocal electroretinogram (MF-ERG) parameters. The study included two groups. Group 1 included 50 diabetic patients with senile cataract (50 eyes, 30 females, 20 males, aged 55±7y) received nepafenac 0.1% eye drop. Group 2 included another 50 diabetic patients with senile cataract (50 eyes, 22 female, 28 males, aged 53.8±8y) did not receive nepafenac. All patients were followed up for 3mo postoperatively. OCT and MF-ERG were done preoperative and at 1wk, 1, 2 and 3mo. The mean foveal thickness was statistically significantly lower in Group 1. Five eyes in Group 2 developed clinical cystoid macular oedema (CMO) (10%), and no patients in Group 1 developed central macular thickening more than 50 µm. There were insignificant differences in MF-ERG amplitudes and latencies between the two groups except in the five eyes that developed CMO, there statistically significant reduction of MF-ERG amplitude with increase in foveal thickness. Perioperative nepafenac reduces the incidence of CMO following uncomplicated phacoemulsification significantly. Nepafenac has no side effects.

Results of secondary retropupillary-fixated intraocular lens implantation

To evaluate specific morphofunctional changes in the eye after dislocated IOL exchange with retropupillary-fixated iris-claw IOL. Surgical outcomes of 150 patients (150 eyes) with in-the-bag IOL dislocation (122 eyes) or sulcus-fixated IOL dislocation (28 eyes) were analyzed. The follow-up period was 1-3 years. Increase in visual acuity and stable retropupillary fixation of the IOL was observed in all cases after reimplantation. Mean endothelial cell loss after 3 months was 6.9±1.3% in the group with preoperative density of >1200 cells/mm2 and 12.3±2.7% in the group with preoperative density of <1200 cells/mm2. There was no significant increase in intraocular pressure after IOL reimplantation. The incidence of clinical cystoid macular edema with decreased visual acuity was 4.7%, which is significantly more frequent than in patients after uncomplicated phacoemulsification with in-the-bag IOL implantation. Retropupillary implantation of iris-claw IOL provides stable fixation, good functional outcomes with low complication rates and is suitable for reimplantation in eyes without adequate capsular support.

Pseudophakic cystoid macular edema and spectral-domain optical coherence tomography–detectable central macular thickness changes with perioperative prostaglandin analogs

To define the incidence of cystoid macular edema (CME) and spectral-domain optical coherence tomography-detectable (SD-OCT) subclinical changes in central retinal thickness in patients using prostaglandin analog (PGA) eyedrops after phacoemulsification. Royal Bolton Hospital, Bolton, United Kingdom. Prospective case series. A consecutive analysis of the incidence of postoperative CME after phacoemulsification by a single surgeon was performed in eyes of patients using PGA eyedrops between March 2010 and January 2014. The presence of CME was determined using SD-OCT (Cirrus) 3weeks and 6weeks postoperatively. Exclusion criteria included preexisting pathology known to predispose to CME and previous ophthalmic surgery. The paired Wilcoxon signed-rank test was used to compare central retinal thickness measurements at baseline and 3weeks and 6weeks postoperatively. All 48 patients (mean age 78.4years; 60 eyes) had uneventful surgery. There were no cases of clinically significant CME. Subclinical CME detected by SD-OCT was confirmed in 2eyes of different patients (3.3% of eyes), 1 eye 3weeks postoperatively and another eye at 6weeks. Subclinical CME resolved in both cases within 8weeks. In both cases, the difference in central retinal thickness at baseline and 6weeks postoperatively was statistically significant (P<.05). The incidence of subclinical CME detectable on SD-OCT after routine phacoemulsification in patients using PGA eyedrops throughout the perioperative period was 3.3%. There were no cases of clinical CME. These findings might guide clinicians in their decision to use PGAs perioperatively.

Risk factors for and diagnosis of pseudophakic cystoid macular edema after cataract surgery in diabetic patients

To evaluate the risk factors and potential diagnostic criteria for pseudophakic cystoid macular edema (CME) in diabetic patients after phacoemulsification. Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, China. Prospective nonrandomized study. Diabetic patients were followed for up to 6months after cataract surgery and examined to evaluate their foveal thickness, macular sensitivity, and corrected distance visual acuity. Multiple statistical analyses were performed to determine risk factors and diagnostic criteria for pseudophakic CME. The duration, type of diabetes, stage of diabetic retinopathy, nuclear opalescence grading, glycosylated hemoglobin A1c (HbA1c), and ultrasound time were correlated with the change in foveal thickness and macular sensitivity after cataract surgery. Unsupervised data analysis showed 3 groups of patientsas follows: nonpseudophakic CME, level 1 pseudophakic CME, and level 2 pseudophakic CME. Subclinical level 1 patients had a 30% to 40% increase in foveal thickness 1month postoperatively, while level 2 patients had at least a 40% increase in foveal thickness and a 20% decrease in macular sensitivity. The incidence of clinical pseudophakic CME was 3.2% in diabetic patients as per the diagnostic criteria. The change in macular sensitivity was more consistent and correlated with foveal thickness. The duration, severity, type of diabetes, hardness of the lens, and HbA1c were risks for pseudophakic CME in diabetic patients after cataract surgery. A 40% or more increase in foveal thickness and 20% or more decrease in macular sensitivity offer an objective and reliable diagnostic standard to report pseudophakic CME in diabetics.

Postsurgical Cystoid Macular Edema.

Cystoid macular edema (CME) is a primary cause of reduced vision following both cataract and successful vitreoretinal surgery. The incidence of clinical CME following modern cataract surgery is 0.1-2.35%. Preexisting conditions such as diabetes mellitus and uveitis as well as intraoperative complications can raise the risk of postsurgical CME. The etiology of CME is not completely understood. Prolapsed or incarcerated vitreous and postoperative inflammatory processes have been proposed as causative agents. Pseudophakic CME is characterized by poor postoperative visual acuity. Fluorescein angiography shows the classical perifoveal petaloid staining pattern and late leakage of the optic disk. Optical coherence tomography is a useful diagnostic tool, which displays cystic spaces in the outer nuclear layer. The most important differential diagnoses include age-related macular degeneration and other causes of CME such as diabetic macular edema. Most cases of pseudophakic CME resolve spontaneously. The value of prophylactic treatment is doubtful. First-line treatment of postsurgical CME should include topical nonsteroidal anti-inflammatory drugs and corticosteroids. Oral carbonic anhydrase inhibitors can be considered complementary. In cases of resistant CME, periocular or intraocular corticosteroids present an option. Antiangiogenic agents, though experimental, should be considered for nonresponsive persistent CME. Surgical options should be reserved for special indications.

Cystoid macular edema after femtosecond laser–assisted versus phacoemulsification cataract surgery

To evaluate the incidence of postoperative clinical cystoid macular edema (CME) associated with femtosecond laser-assisted cataract surgery (Catalys laser system) versus phacoemulsification cataract surgery. Launceston Eye Institute, Launceston, Tasmania, Australia. Nonrandomized, single-surgeon, prospective, comparative cohort case series. Patients who had femtosecond laser-assisted cataract surgery and phacoemulsification cataract surgery between March 2012 and July 2014 were included in the study. The femtosecond laser-assisted cataract surgery group had anterior capsulotomy, lens fragmentation, with or without corneal incisions via femtosecond laser pretreatment. Standard phacoemulsification surgery and foldable acrylic intraocular lens insertion proceeded in all cases. All patients received topical nonsteroidal drops commencing 2 days preoperatively and continuing for 4 weeks postoperatively. The incidence of postoperative clinical CME (confirmed by optical coherence tomography) and comparison between groups were measured. The main outcome measure was the clinical CME rates. Of the eyes, 833 had femtosecond laser-assisted cataract surgery amd 458 had standard phacoemulsification cataract surgery. Both groups had similar baseline parameters. There were 7 cases of postoperative CME (0.8%) in the femtosecond laser-assisted cataract surgery group compared to 1 case (0.2%) in the phacoemulsification cataract surgery group, highlighting a trend toward greater cystoid macular edema in the femtosecond laser-assisted cataract surgery group. This correlated with a change in laser treatment speed (due to a software upgrade), suggesting that retinal safety thresholds need further careful analysis. Increased CME might be a subthreshold retinal injury safety signal after femtosecond laser pretreatment and warrants further study. There are no financial or conflicts of interest for any author.

Prospective study of incidence of cystoid macular edema in uneventful cataract surgery: a study of 100 cases

Background: Cystoid macular edema (CME) is the important postoperative complication of cataract surgery, which can compromise the result of a cataract surgery. It can occur even after uneventful cataract surgery, but the incidence rapidly increase after complicated cataract surgery. Fundus fluorescein angiography (FFA) has been used for long time for diagnosis of cystoid macular edema. Angiographic CME, which is the presence of fluorescein leakage within the macular area without visual impairment, must be differentiated from clinical CME. The incidence of the two forms is different, with the angiographic form being much more common. Angiographic CME was reported to occur in 3–70% of the patients 4–6 weeks after cataract surgery. Objective: To study the incidence of cystoid macular edema in uneventful cases of small incision cataract surgery (SICS). Materials and Methods: This prospective study comprised 100 eyes of 100 patients who have undergone SICS with IOL implantation. Incidence of CME was found with the help of FFA. Results: In the study, 40 male patients and 60 female patient who underwent uneventful SICS of whom 20% male were CME positive and 20% female were CME positive. Angiographic CME (20%) incidence was more than clinical CME (2%). The incidence of CME was more on 30th post-operative day as compared to 7th post-operative study. intracameral adrenaline increases the incidence of CME. Conclusion: Incidence of clinical cystoid macular edema is 2% in uncomplicated cataract surgery, incidence of angiographic cystoid macular edema is 20%.

Prospective, Randomized Study Comparing the Effect of 0.1% Nepafenac and 0.4% Ketorolac Tromethamine on Macular Thickness in Cataract Surgery Patients With Low Risk for Cystoid Macular Edema.

This study aimed to compare the short-term efficacy of 0.1% nepafenac with that of 0.4% ketorolac tromethamine in patients with low risk factors for cystoid macular edema (CME) undergoing phacoemulsification. A prospective, randomized, parallel-assignment efficacy trial. Two hundred eyes of 200 patients were randomized into 2 groups, one receiving nepafenac and the other receiving ketorolac perioperatively. Primary outcome measures were change in central macular thickness (CMT) at the 30th postoperative day and the incidence of possible subclinical CME (increase in CMT of >10 and >40 μm from baseline) on ocular coherence tomography (OCT). Secondary outcomes measured were the incidence of definite subclinical CME on OCT (>40 μm increase in CMT from baseline) and clinically significant CME at 1-month follow-up. A subgroup analysis of diabetic and hypertensive patients included in the study was made postoperatively. Difference in CMT at 1 month (P = 0.43) and presence of possible subclinical CME (P = 0.18) were comparable in both groups. The incidence of possible subclinical CME was 22.7%. None of the patients developed clinical CME or definite subclinical CME. In the diabetic subgroup, nepafenac showed significantly less CMT difference than ketorolac did at 1 week after the operation (P = 0.04) but not at 1 month (P = 0.09). Postoperative macular thickening after cataract surgery in eyes with low CME risk is similar with nepafenac and ketorolac. A larger population of diabetic patients should be studied to verify any beneficial effect of nepafenac on this subgroup.

Fibres found in the eye during and after phacoemulsification cataract surgery.

Fibres are regularly found within the delivery cartridge (DC) and in the anterior chamber (AC) during phacoemulsification cataract surgery (PCS) and postoperatively. The purpose of this study was to identify their frequency and possible significance. Dedicated ophthalmic day surgery. Prospective, consecutive, single-surgeon, cohort study. In 639 eyes undergoing PCS, the presence of fibres was documented in or on both the DC and in the AC intraoperatively, and in the AC postoperatively. The intraoperative method of fibre removal was documented. Corrected distance visual acuity (CDVA) was recorded preoperatively, and at day 1, week 1, and week 4 postoperatively. The incidence of clinical cystoid macular oedema (CMO) and endophthalmitis in the retained fibre subcohort was compared with that of the non-fibre subcohort. A total of 5.2% of the operated eyes had a fibre or fibres in or on the DC, which in all cases was removed with forceps intraoperatively. A total of 14.6% of operated eyes had a fibre or fibres in the AC intraoperatively; these were removed by irrigation/aspiration. Postoperatively, five eyes (0.78%) had a fibre in the AC. There was no significant difference in postoperative CDVA between the fibre and non-fibre subcohorts (P=0.26), and no clinically significant CMO or endophthalmitis in either subcohort. Most fibres seen on the DC or in the eye are sterile and non-inflammatory. However, there have been reports of endophthalmitis attributed to retained fibres. In this study, there were no complications attributable to the fibres, but their removal may minimise any adverse potential.

Prophylactic use of ketorolac tromethamine in cataract surgery: a randomized trial.

To determine the efficacy of topical ketorolac tromethamine in preventing cystoid macular edema (CME) after uncomplicated cataract surgery. This single-center, prospective, double-masked, randomized clinical trial consisted of 81 patients who were scheduled for cataract surgery. Patients were randomized to receive hypromellose/dextran 70 as a placebo (n=44) or ketorolac tromethamine 0.4% (n=37) as an adjuvant therapy. These eye drops were administered 4 times daily (QID) for 3 days before surgery and 5 weeks postoperatively. All patients received prednisolone acetate 1% QID during the same period as basal/standard anti-inflammatory therapy. The primary outcome was the incidence of angiographic CME 5 weeks after surgery. The secondary outcomes were mean change in best-corrected visual acuity (BCVA) [Early Treatment Diabetic Retinopathy study (ETDRS)], clinical CME incidence, intraocular pressure, and retinal thickness measured using optical coherence tomography (OCT). In the placebo group, 2/44 (4.5%) patients and in the ketorolac group, 2/37 (5.4%) patients presented with angiographic CME (P=0.624). The mean change in postoperative BCVA was 32±15 letters in the placebo group and 26±16 letters in the ketorolac group (P=0.07). There were no statistically significant between-group differences in the mean central subfield thickness (P=0.679), minimal central thickness (P=0.352), or central macular volume (P=0.729). There was no difference between ketorolac tromethamine and a placebo with regard to BCVA results or prevention of CME after uncomplicated cataract surgery.

Pathogenesis of Pseudophakic Cystoid Macular Oedema

Cystoid macular oedema (CMO) is a primary cause of reduced vision after cataract surgery even after uneventful surgery. The incidence of clinical CMO following modern cataract surgery is 1.0-2.0 % but the high number of surgeries performed worldwide makes this entity an important problem. Pre-existing conditions such as diabetes and intra-operative complications increase the risk of developing CMO post-operatively. CMO is caused by an accumulation of intra-retinal fluid in the outer plexiform and inner nuclear layers of the retina, as a result of the breakdown of the blood-retinal barrier. The mechanisms that lead to this condition are not completely understood. However, the principal hypothesis is that the surgical procedure is responsible for the release of inflammatory mediators, such as prostaglandins. Optical coherence tomography is at present an extremely useful non-invasive diagnostic tool. Guidelines for the management CMO should be focused essentially on prevention and are based on the principal pathogenetic mechanisms, including the use of anti-inflammatory drugs.

Pathogenesis of Pseudophakic Cystoid Macular Oedema

Cystoid macular oedema (CMO) is a primary cause of reduced vision after cataract surgery even after uneventful surgery. The incidence of clinical CMO following modern cataract surgery is 1.0–2.0 % but the high number of surgeries performed worldwide makes this entity an important problem. Pre-existing conditions such as diabetes and intra-operative complications increase the risk of developing CMO post-operatively. CMO is caused by an accumulation of intra-retinal fluid in the outer plexiform and inner nuclear layers of the retina, as a result of the breakdown of the blood–retinal barrier. The mechanisms that lead to this condition are not completely understood. However, the principal hypothesis is that the surgical procedure is responsible for the release of inflammatory mediators, such as prostaglandins. Optical coherence tomography is at present an extremely useful non-invasive diagnostic tool. Guidelines for the management CMO should be focused essentially on prevention and are based on the principal pathogenetic mechanisms, including the use of anti-inflammatory drugs.

Macular edema and visual outcome following cataract surgery in patients with diabetic retinopathy and controls

Cystoid macular edema (CME) is a well-known complication after cataract surgery, and diabetic retinopathy is reported to be an important risk factor for impaired visual recovery. In this prospective study, we compared visual outcome 6months after surgery in eyes with moderate retinopathy and no previous ME with a control group, and observed the incidence of ME seen on fluorescein angiography (FA) and optical coherence tomography (OCT). Thirty-four patients with type-2 diabetes and 35 controls were enrolled. Best-corrected visual acuity (VA) letters ETDRS was measured pre-op, at day 7, week 6 and month 6. FA performed pre-op and at week 6 was divided into three leakage patterns. OCT performed pre-op, at week 6 and month 6 was qualitatively divided into three types. Macular thickness was measured in three circular fields (central subfield, inner and outer circle) from the macular maps. There was no statistically significant difference in VA before surgery, at day 7 or at 6months, but at 6weeks there was a significant difference with lower VA in the diabetic group. Six percent of control and 12% of diabetic eyes developed a clinical CME defined as a loss of >5 letters between day 7 and week 6. Incidence of FA leakage was 23% in control and 76% in diabetic eyes. At 6weeks, 20% of control and 44% of the diabetic eyes had qualitative changes on OCT. A statistically significant increase in thickness was observed for all three macular areas in both groups, part of it remaining at 6months. There were, however, no differences in central macular thickness between the groups at any visit. Retinal thickening had poor correlation with VA. The final visual outcome in eyes with mild to moderate retinopathy, without previous ME, is as good as in normal eyes, but an increased frequency of macular changes may protract recovery of full vision. Changes on OCT or FA are often seen without any obvious effect on VA. OCT is as good as FA at detecting a clinical CME, and is the technique recommended for follow-up before FA is considered.

Treatment of postoperative macular edema

Abstract Purpose Cystoid macular edema (CME) is a frequent complication of a number of interventions in ophthalmology, such as cataract surgery (Irvine‐Gass syndrome), laser procedures, and trabeculectomy. The purpose of this talk is to present the latest bibliographic data regarding the appropriate treatment of postoperative CME. Methods A review of the existing literature concerning the treatment of postoperative CME is performed. Characteristic personal cases are presented. Results In more than two‐thirds of the cases, postoperative CME resolves spontaneously within weeks or months. Prophylactic topical treatment with indomethacin or flurbiprofen seems to reduce the frequency of clinical and angiographic CME, but its beneficial effect on final visual acuity is not established. Curative therapy includes topical corticosteroids; topical non‐steroidal anti‐inflammatory drugs (e.g. ketorolac); oral acetazolamide; sub‐Tenon or intravitreal injection of triamcinolone acetonide; intravitreal injection of anti‐VEGF drugs; and pars plana vitrectomy. The indications, role, and efficacy of each of the above treatment modalities are discussed, based on the latest bibliographic data. Conclusion Most cases of postoperative CME are mild and resolve spontaneously. In refractory cases, sub‐Tenon or intravitreal injection of triamcinolone acetonide can be effective, but the risk of ocular hypertony is high. Intravitreal injection of anti‐VEGF drugs offers promising results, yet large‐scale randomized studies are necessary to validate their utility. Finally, pars plana vitrectomy is the treatment of choice when vitreomacular traction and/or epiretinal membrane is present.

Clinical Cystoid Macular Edema After Cataract Surgery in Glaucoma Patients

To determine the prevalence of and risk factors for developing clinical cystoid macular edema (CME) after cataract surgery in patients with glaucoma.Medical records of patients who had cataract surgery between April 1998 and July 2006 without prior history of CME, a known risk factor to develop CME, or previous nonglaucoma ocular laser procedures or intraocular surgeries were reviewed. Clinical CME was diagnosed by fundus examination within 3 months postoperatively and confirmed with fluorescein angiography or optical coherence tomography. Outcome measures included prevalence of clinical CME by comparing patients with and without glaucoma; and risk factor analysis for clinical CME by comparing patients who did and did not develop CME after cataract surgery.Seven hundred patients (eyes) with glaucoma and 553 patients (eyes) without glaucoma were included. The prevalences of clinical CME in glaucoma and nonglaucoma patients were 5.14% and 5.79%, respectively (P=0.618). Patients who developed clinical CME (68 patients) had statistically higher rates of posterior capsule rupture or required anterior vitrectomy during surgery (P=0.010, odds ratio=3.35, 95% CI 1.33-8.45) compared with patients who did not develop clinical CME (1185 patients). No glaucoma medications used either preoperatively or postoperatively were associated with clinical CME (P>0.05).Rupture of posterior capsule and anterior vitrectomy during cataract surgery is a potential risk factor for developing clinical CME after cataract surgery. There is no statistically significant difference in the prevalence of clinical CME after small corneal incision phacoemulsification cataract surgery between glaucoma and nonglaucoma patients.

Clinical cystoid macular edema after cataract surgery in glaucoma patients.

To determine the prevalence of and risk factors for developing clinical cystoid macular edema (CME) after cataract surgery in patients with glaucoma. Medical records of patients who had cataract surgery between April 1998 and July 2006 without prior history of CME, a known risk factor to develop CME, or previous nonglaucoma ocular laser procedures or intraocular surgeries were reviewed. Clinical CME was diagnosed by fundus examination within 3 months postoperatively and confirmed with fluorescein angiography or optical coherence tomography. Outcome measures included prevalence of clinical CME by comparing patients with and without glaucoma; and risk factor analysis for clinical CME by comparing patients who did and did not develop CME after cataract surgery. Seven hundred patients (eyes) with glaucoma and 553 patients (eyes) without glaucoma were included. The prevalences of clinical CME in glaucoma and nonglaucoma patients were 5.14% and 5.79%, respectively (P=0.618). Patients who developed clinical CME (68 patients) had statistically higher rates of posterior capsule rupture or required anterior vitrectomy during surgery (P=0.010, odds ratio=3.35, 95% CI 1.33-8.45) compared with patients who did not develop clinical CME (1185 patients). No glaucoma medications used either preoperatively or postoperatively were associated with clinical CME (P>0.05). Rupture of posterior capsule and anterior vitrectomy during cataract surgery is a potential risk factor for developing clinical CME after cataract surgery. There is no statistically significant difference in the prevalence of clinical CME after small corneal incision phacoemulsification cataract surgery between glaucoma and nonglaucoma patients.

Incidence of postoperative cystoid macular edema by a single surgeon.

To evaluate the clinical and angiographic incidence of cystoid macular edema (CME) after cataract surgery, and to determine the impact of intraoperative triamcinolone acetonide. This is a prospective, single-center trial looking at 81 eyes of 61 patients who underwent clear-cornea incision phacoemulsification with lens implantation under topical anesthesia by a single surgeon. Outcome measures included clinical and angiographic CME, the impact of operative time, medications, and systemic disease on the presence of CME. Eight eyes (9.87%) demonstrated angiographic CME at the one-week and six-week follow-up visits. Two eyes showed evidence of clinical CME (2.46%) on examination. Subjects with diabetes had an increased risk of angiographic CME. The incidence of clinically significant and angiographic CME in this study is confirmatory of previous studies in the literature. The use of intraoperative subconjunctival triamcinolone acetonide did not appear to significantly reduce the development of post-operative CME.